i am not say moderator positions, because again, i talk at the end of the book about how i think persuadable, moderate, middle- of-the-road, whatever you want to call voters in that what i found in my state and in , people votedce for both me and barack obama are obviously not people who do not necessarily to be perfectly aligned. what did i want more than anything who have bold ideas that are aggressively putting those out. in the state, oprah's boat, fundamental -- on principle, fundamental issues, to come out and say to win elections, i need to change my -- you will lose votes. they want to respect. ado not want to bite it was

perfect, identical rebel. -- replica. they want to know that they respect first and foremost that elected official. he or she has a course of principles they wanted to stick with. secondly, to my larger point, they want to know even if they to people whatn no problem voting for me even though they do not share my belief on that particular issue because that effect that the things i focus in on even on the fiscal issues in my state and that is what they feel they hired me to do. i use example outside of politics. bei were hiring somebody to the chief executive of a company i had and i said he or she was exceptional chief executive of a smaller company, here are the two things i want him to focus

on. development and sales. if -- itnot bother me would but i would get over it if they were a vikings are bears fan and i could get over it. as long as they got -- they do not focus on that. voters who are different on things like gay marriage and abortion do not really need to worry that you are going to do anything to change laws because your marketers in -- >> much of the debate and the question asked earlier sometimes of these issues are interest -- different jurisdictions. an example i got asked about same-sex marriage formula simple, i set i said it is in the constitution. i was not hiding a secret agenda.

-- i said it was and the constitution. state,re in a different it might be. >> yes, sir? europe has a couple of laws. -- you have passed a couple of law banks. -- laws. are you concerned if you do not want to talk about it they will was mark >> sure, i talk about in my book. half,nt a month and a very ineffectively -- he spent a month and a half, very ineffectively. my answer was simple. voters just care about water to issues. i found the man and the women in my state what they wanted to know what i continue to move forward with reforms and get the

budget balanced at lower our debts and move our economy and improve our schools and higher education. that is what i talked about in my recall election. but medgenics -- >> medicaid expansion. bit -- cang little you talk a little bit? how it is moving and your response? >> last week i called a special session. politically, it would've been great for me to say, i told you so. going to said, i'm not let the people my stator depending on the program to fall through the cracks just go the failures of the federal government. concept.ot a new to latest buzz has been how respond to this. we said back in february when i

introduced my budget what we were doing and why, essentially it was the law. i am not go to ignore it. but he said thomas daschle but we said, all the way to june -- but we said, all the way to june the exchanges were not in place. our transition was postponed equivalent with that delay. what we found in the last few people thatd 877 were signed up. what we found was after weeks hhsweeks of age sss -- myik my office -- telling office that things were coming together and they were saying reporters,ings to and is obsolete not going to work. -- it is obviously not going to work.

we are not going to let people fall through the cracks. i called a special session. are going to do the medicaid transition and reinstate a very successful program we had before . it is a high risk insurance pool for people can pay at higher mouse and get access to health insurance in our state -- a higher premium and get access to health insurance in our state. we send will extend that for three more months to keep them on board and we asked secretary to give us aius change which they are reluctant. in many of our counties, we actually have were qualified health plans outside of the exchange that we do in the exchange. ifasked them to consider

somebody qualifies that they authorize a use the subsidy that they purchased the plan under the exchange. the idea that would free up some of the volume that would have to go to the exchange and make it easier. it is the law. said since day one, the difference is we assume that if there was a delay, it would be an intentional delay where the administration and the congress would say, it is not ready yet you would need to push back. we are not there legally. it's just practically not working. >> i wanted to ask a question about something you talked about , negotiations with iran. that agreement. ahead,d in 2014, looking

--eign policy [indiscernible] what is your larger critique of the obama administration? >> on the wider part i will answer as an american. couple of months ago, i was in tokyo for a trade mission. i made it easier to fly out to the west coast. i stopped to kill time with george shultz. general toresting in spend an hour and a half before we took off. at the time, it was when the debate about syria. i asked him about that. he told when interesting story. maybe you know secretary schultz was a marine in world war ii. before heabout how went into war he went to boot camp. at how his sergeant told him and

gave from his firearm and said, this is your firearm, it'll be your best friend and you will live with and sleep with it. the most important thing i can tell you is do not point it at it when you are not prepared to shoot. inc. abouthe did not it, is an old world war ii veteran telling war stories. really very profound insight on foreign policy today here and around the globe. what i mean is, one of the biggest frustrations i have had as an american with what is going on in foreign policy is much like obama care and other issues, a president who spend too much time listening to his political team and not policy team. and pushing things that may not in terms set reality of policy implications but

politically might sound nice. i think that is dangerous territory whether republican or democrat. advocateeven going to whether we should or should not have withdrawn the red line. you have to set the standard about if you say something, you have to mean something to your allies and it has to mean something to your adversaries. one of the reference in the book i mentioned something early on about monday before we put our budgets reforms, i invited my cabinet to the executive resident in medicine. -- in madison. i sat down and i knew it would not be that tough but tough. i talked about how reagan, the presencee took on -- he took on. it do something much smaller scale. i pointed out in my humble

took an that when he air traffic controllers that had a much more profound effect than issues. that sent a powerful message around the world that this was a serious president. a president that was not going to say something to do something differently. a president that was serious. it was part of the end of the cold war back to the element of early on. if you look back at history, reagan had very few military engagements. in large part because his adversaries new this let died not to be messed with because he was going to do what he was going to do. >> we have a few minutes left. >> at the state level, there are

certain things the president can do. if the next president is a republican, what should they do to protect and strengthen the institution of traditional marriage and reduce the number of abortions in the country? >> two things. to makebeing insulting, my point about how media seems to be more obsessed with social issues and the average voter. that aside, in terms of the president, i do not know. i have not spent a lot time the things we try to do in our state in terms of marriage in general is look at ways you can help lift people out of poverty. make it easier to get to work and help with early development especially with reading. those are the sorts of things would've hoped to strengthen families and it makes for strong marriages. looking ating with

terms and reducing the number of abortions or other things. the whole spectrum from safe toens to prenatal assistance making it easier for adoption. at the national and federal level, and the stock something i really know. >> unfortunately, we are out of time. -- it is something i have not really looked at. >> thank you. [captions copyright national cable satellite corp. 2013] [captioning performed by national captioning institute]

>> today marks 50 years since the assassination of john f. kennedy. eric holder visited the kennedy gravesite. coin at theive site. he wanted the short path to the grave of robert kennedy. the current attorney general about his head and left a coin in there as well. his head and left a coin there as well.

>> all this weekend, on c-span 3 we remember jfk 50 years after dallas with interviews from secret service agents.

a news rails from after the assassination and two of the doctors from parkland memorial hospital. s from after the assassination and two of the doctors from parkland memorial hospital. will show you the nbc coverage reporting on the assassination of jfk. weekend, american history tv looks back at the assassination of jfk and its aftermath was eyewitness accounts, scenes from the president reagan to texas and commemorative events from the ley plaza. -- dea and your chance to talk to historians. p.m., november 22, author. coverage continues on sunday with a lyndon johnson's address to congress. your questions live with lbj

biographer and presidential historian. followed at 6:00 p.m. with nbc state funeral. remembering jfk on american tv this weekend on c-span 3. fun to have it was a little view of history of a time in america that was not --tructional for the instructional. and a more anecdotal little bit more archaeological meaning random. you look at them as he bunches of where photos and the captions explaining down. i had a vision of high school students flipping through them and loving history if they could. moves from cable to author with "the big picture."

>> alliance health reform held a discussion about the rollout of the marketplaces under the affordable care act. sara collins of the commonwealth showingeased a survey 200,000 people have signed up for coverage so far. of this law, the affordable care act, the degree it is being implemented at the state level and the local politics and decision-making will influence outcomes across the country both in states and nationally. this is in particular played out over the last couple of months andhe large we have seen functionality and the ease at which people are able to get this the marketplaces and in a role. in terms of the marketplace, marketplaces themselves in 16

states and the distant columbia are running their own marketplaces. -- aict of columbia district of columbia are writing their own marketplaces. idaho and new mexico are using get for enrollment. that means 36 states are using inlthcare.gov to enroll health plans. state participation in the medicare expansion will have a significant impact on enrollment. days and the district of columbia are expanding their programs. 24 states are undecided or are not going to expand. the congressional budget office is saying by 2018, 50 million people will enroll. they're expecting 7 million people to enroll in 2014 was a and medicaid, they are projecting 9 million people to enroll next year.

the central question on everybody's mind, will consumers enroll? whole will enroll? -- who will enroll? the young and healthy? this is going to be credible -- critical to stabilization over time. to learn what people are experiencing during the first inks, the commonwealth found october, we interviewed a national sample of adults who are potentially eligible for marketplace options or medicaid. people who are uninsured or are purchasing and the insurance market. we found 60% of those adults were aware of the marketplace and october up from one third of the group and a similar survey we conducted in the summertime.

adults reported visiting in october of stop the age and how the distribution of those who went to the marketplaces and reflected that of the eligible population. 19-29.ne in five were nearly three quarters were in good health. in five however said they actually enrolled in a health plan. we asked people who do not inoll why they had not october. 48% in the survey said they did not because they were not certain they could afford a plan. 40% said they were still trying to decide which plan they wanted. 37% cited technical difficulties on the website. a majority of survey respondents appeared determined to come back to gain insurance coverage over the next few months. if the eight percent of those who had not gone -- 58% of those

who had not gone said that were somewhat likely to visited by plan orto enroll in a find that there were eligible for financial assistance. young adults were likely as older adults to say there were going to the marketplace by the end of the period. widespread support for expanding medicaid in the state. saidy 75% of respondents they were strongly or in favor of making medicaid more available to residents. difficulties involved in the rollout of health care.gov at some the other marketplaces, the latest november enrollment figures in 14 states that are running the marketplace and it has climbed to around 200,000 people nationwide. that's a pretty good as a man -- estimateiation that has variation around it.

that is up for 106,001 had selected a plan. figure does not account for the many new and release who probably -- enrollees who probably gained coverage and will find out what those numbers look like in the next few weeks. many states are also reporting significant enrollment in medicaid programs. among those who are running their own marketplaces and are haveding, 340,000 people enrolled in the programs. it is really too early to assess the age and health situation of the marketplace enrollees. there is evidence as a young adult are enrolling. reward your skin next it -- reuters reported that 20% -- we about theerday that same percentage of young adults

hadenrolled implants and -- enrolled in plans in california. numbers do show that people are determined to gain coverage despite the obstacles that are currently dealing with. as a the websites are prepared, which is the growing enrollment across the country. >> ok. thank you very much, sara. a couple of housekeeping items. a video recording of this briefing available probably monday on our website. there will be a trip script of global shortly after that. a transcript available shortly after that. you see the slides and back ground material you have in your ons on the website -- kits the website. at his important to those you

who may be watching on c-span. you can go to allhealth.org. you can see the slides and do the background and it is embodied in the materials that the folks and personal attendants have at their disposal. at the appropriate time, you are going to be up to ask questions of the panel. either by filling out the green question card in your kit or by kind to one of the microphones that you can see in the audience. the briefing, we would appreciate you pull it out of the blue evaluation form and giving us feedback that will allow us to improve the briefings for you in the future. let's get to the discussion. we have a terrific lineup for you today with a national and

state at community level perspectives. whatll help you understand a lot of the noise you hear is really about to stop we will , -- reallymatt salo about. -- we will start with matt salo. many of you may know him from his work many years at the national governors association working on health reform agendas . today, we asked him to tell us about how enrollment is going into medicaid in the various states. as sara pointed out, enrollment in medicaid is outstripping active aromas in the exchange plans themselves stop what is happening -- themselves. -- what is happening? >> thank you for hosting this and everybody here.

really exciting to see a large group of people come together to hear about what is happening in medicaid and the marketplaces. about i get into talking some of the medicaid and marketplace dynamics, and supported to give a little -- it is important to give pretax. what is this program? we talked about numbers. where 27 million here, 9 million here. is important to put it into context. the largest and most important program you probably do not know anything about. we have 72 million americans walked through the doors at some point in time last year in medicaid and or chip. the largest health insurance program in the country. we spent $430 billion last year. what does it look like? the face of medicaid is pregnant

women, kids, working families. all of the dollars in medicaid are in seniors, people with disabilities home a long-term care. -- disabilities, long-term care. again, whether you adore or a hor, one half of the $1 trillion that the aca spends over a 10 year window according to cbo my half of that is in medicaid. it is going to get a bigger. i want to put it out there and put context. one of the things within doing is trying to monitor how the state experience has been going to get ready for october 1 and a chamber room one. -- and a january 1. we started in august with a monthly snapshot looking at states and what their experience has been.

, october 1, we shifted back to weekly. it's a lot of work for our members. it is really important because we felt this experience needed to be shared with folks to get a sense of what is going on. all of this information, the monthly and the weekly is of global right now on our website. ors.org.direct sign-up up for our newsletter. it is great. a couple days ago we released a snapshot with a broad state perspectives on how things have been going for the past couple of months. we have been told about stays and some the stuff does not sound very sexy but it is designing the system to make it work. how medicaid interfaces with the marketplace. the enrollment efforts the states are undertaking. at the end of the day, how do we

do this in a way that really benefits the consumer? is their experience really matters here and if they are not happy, they are not calling president obama if they are not happy with the consumer experience, they are calling us. it is incumbent upon us to figure out how to meet his work as best as we can for them. a point that cannot be stressed enough. -- notg of systems like very sexy, this is really hard work. states come from different perspectives. thatve a lot of states eligible to systems that were built in the 1980's. this is a terrific opportunity for many of them to modernize what they have been doing. unfortunately, put into retirement some of old fogeys who are doing something in a

basement somewhere. nobody else around the systems. states are coming from different perspectives. here's a point that is really important. regardless of whether a state has made the decision to expand medicaid or not, to do a state exchange or federal exchange, every single state has had to do enormous work in a totally overhauling a lot of their systems and ensuring this connectivity with the federal data hub and the exchange. this is building eligibility systems, reworking your application procedures, and out of the business processes -- and all of the business processes. how you communicate that information seamlessly with the , once youinking about

get people in, how to make sure you have the delivery infrastructure in place to make sure that that the high-quality care they need? this is a lot of work. anybody who goes around saying, and is just a website, how hard can it be? they obviously have no idea what they are talking about stuff is the most competent stuff that is ever been done. you are talking about -- comitatus stuff that has ever been done. -- you are talking about real- time between hhs, department of labor, irs, treasury, homeland security. that is just on the federal data hub. statennecting that to 50 agencies. this is not starting up amazon.com. visit manhattan project. this is a manhattan project.

the state experience with procuring and developing and building i.t. systems is not a real pretty one. we hear from our states that the basic rule is, the number of times that a system you procure comes in on time, on budget, and to spec is basically never. it does not happen. we have been saying for months, this is going to take time. roll out going to be bumpy. rollout has been bumpy. these things do get fixed. obviously, the challenges and that healthcare.gov are out there. states have had their challenges with trying to build their own state systems. keep in mindnt to again, we work in a real-world here and these things take time. , what the numbers tell

us? a couple of things. it's a little too early to be drawing a broad conclusions. we are less than eight weeks in. we had data from a relatively small number of states. but i think what we can see from the numbers is that medicaid enrollment is higher than people thought. it is higher than the exchange. there are a lot of reasons for that. the states that have a state exchange, the states that are doing the medicaid expansion, it is a kind event diagram. a strong correlation. diagram. looking at snape the beneficiary roles. beneficiary you know who these people are and their income.

you know they are ok getting government benefits. and say weut to them have some you might be interested in -- medicaid, and is not a surprise they come back to large numbers as that we are interested. who will those numbers be sustained? no. what we will see if the medicaid enrollment that would've seen spiking will go down and exchange numbers will go up. in all, what we are seeing are the numbers according to the states will talk to which is pretty much everybody, it is largely consistent in line with what their projections were at the onset. and so what states are really qualityt is a constant improvement process. as they are building systems and interfacing, they are testing and fixing and patching.

sometimes they have to go back and resort to mitigation strategies. sometimes they have to go back and do things with paper. paper enrollments. this happens, it is ok. is a mitigation strategy. the things will be watching for door?ho comes in the are they newly eligible? or the eligible but not enrolled? sometimes call a welcome mat. that makes a huge difference in terms of the government pays for wonder percent of one of the groups. and not anything additional for the other. -- 100% of one of the groups. who is coming again? are they young and healthy? are they older? center -- sicker? it matters. i am out of time. i will rolled her the last slide

or two. the success story, if you can treat the rollout of the exchanges with the medicaid like a soft opening of a restaurant, build functionality early and build upon that -- that is where will see the most success. not always possible, but something would've taken away. finally, october 1 is important tom at january 1 is going to be even more important because coverage actually starts. we have to make sure the system is ready for them. level,, closing, on some coverage is the easy part. once you get them in the door, that is the easy part. with 72 million plus people, all of the sick and the frail and disabled, we have got to do more than get the dome covered. we have to actually improve their health care and bend the

cost curve. terrific jobl is a of explaining it. this is what our states are doing. the really exciting news. reformivery system and the way we pay for care in this country. we have to move away from paying for volume and treating health care like a bunch of economics and towards paying for value. that is is the key and what medicaid is focused on these days. i will stop there and look forward to questions at the end. >> that is great. thank you very much. a great start to the discussion. we'll turn to dan schuyler, director of exchange technology.

the former director of healthogy for utah's exchange which has been in business as long as anybody. dan and his colleagues have been helping a number of states prepare for implementation especially the exchanges. with a asked him to talk about -- with her there are a few challenges and tend not -- we have heard there are a few challenges and technology and with asked him to talk about the other challenges that states are facing in your experience. thank you for being with us. >> today, i am going to give you an overview of health reform in utah and talk about whether theov and state based on marketplaces are doing and sort of try and give guidance to remaining uncertainties. best, it is the fair to point out that health

complexs are the most -- when the most complex i.t. projects ever initiated by the state or federal government. the reason for that is all the points of integration that exchanges need to make. they have to connect with the medicaid and the federal data carriershub and with across the country. with that, i will give you background on what we did in utah. past that08, you top you top past -- utah passed to build an exchange. tool thatprovide a employers could use to help mitigate the rising cost of health care in utah. one of the ways they did that was by establishing a contribution a marketplace which would allow employers to provide their employees with a set

dollar amount that they could use to go into the exchange and purchase any health plan that roosevelt will. it provided -- planet that was available. -- plan that was available. it provided more choices and portability. if they moved from one job to another, they can take their plan. it had been very successful. they have defaulted to the federal marketplace for the individual exchange attempting given a waiver for the shop exchange in utah. with healthcare.gov, what happened? why did we see such a miserable launch? there are two things that really .peak to the failure one was the lack of time to build and test. one of the reasons there was a

lack of time with hhs, cms, sort of delayed the guidance to provide the processes for how an exchange should function. for how the integration should work. all of the nuances with respect to how it should function. to build an airplane while it is in the air. they were sort of trying to develop the rules and regulations and guidance while also planning the development. delayednistration's progress and to know in testing. they tested the components individually but they were not able to because of the time do an and test data led to the and test and -- data led to the issues we saw october 1. they admitted they decided to

take on the role and responsibility of managing the project internally. the demonstration was advised they should leverage expertise in the private sector to manage process. when the largest i.t. project ever initiated by the federal government and they decide to bring it in-house. on october happened 1 with the lack of knowledge and expertise to really guide a project of this size. there was also a lack of communication between the subcontractors and the general contractors. this is part of the overall project management of an i.t. project. the subcontractors would express concern about a certain component or issue and i would never filter up to those in charge who could make the necessary adjustments. to resolve the issues. states and at the

what happened in retrospect with healthcare.gov, what did the state to do differently? and we are seeing much more success. this.hed on they did best practices. they hired integrators and project managers to oversee the implementation. they were pro active. instead of waiting for the guidance to come out, they started the project planning. they started to build and design exchange without the necessary guidance from hhs. that required them to the changes, because they started early, they were able to exchange success that we saw october 1.

they looked at what the core fundamentals of exchange were to start on boarding people. bells and all of the whistles and focus on developing the core fundamentals. they set expectations low. they were very proactive in the media and consumers, letting them know this is going to be a bumpy start on october 1. we are not going to have all of the bells and whistles. we are going to deploy the core functions that will allow people to enroll and begin the process. al in all, they took different design philosophy versus the federal government when it came to build the state based on marketplaces. in retrospect, it may have been better -- and may have been appropriate for the administration to collaborate with the states building an exchange. we may have seen a different outcome with healthcare.gov.

healthcare.gov, they have project management templates and i.t. contractor overseeing. we are seeing progress on a day- to-day aces. -- basis. to theimprovement platform. not sure where we'll be november 30, the administration said at -- november 30 thomas individuals could complete the process and 20% will not be able to because accord design issues that need to be addressed as well as the complexities of specific eligibility. individuals that will have sporadic citizenship or residency were never filed an income tax return. of those will add to the complexity of determining the legibility.

it will be a while before the system can accurately enroll people on a consistent basis. what to see where the platform is ash will have to see where the platform is. -- we will have to see where the platform is. be, we heardan a the administration say through carriers and entities there has been a lot of confusion and in the media about how exactly it works with what the carriers can and can't not to do. the administration is making a proactive decision to encourage consumers to use direct enrollment. does notrn is and fully completed. they are working on the technology to make sure that jerome and past works -- that enrollment path works. they announced last week and there is concern about how that

is going to work and what will happen to premiums. will it be stabilized going forward? there's a lot of uncertainty about what it will do to premiums in 2014. second base exchanges, -- state a base exchanges, which will transition over the next two years. in some respects, the rocky rollout of healthcare.gov will probably be a catalyst for some states include the partnership states to quickly transition and other states that have been opposed to the affordable care them --s may reentry to reentrench them. many of thee partnership states will transition to a state market place. utilizing that are

the federal will transition. last but not least, funding. the federal deficit, what will funding look like for ongoing development of exchanges? states have on till 2014 to apply for grant to build and change. the question will of the funding still be there at the end of next year? thank you. >> thank you, dan. even though you did and with questions instead of answers. we'll get to you later. is next.an she is the winner of the award for the shortest distance traveled by a local official to get to one of our briefings. d.c.s the director of the health benefits exchange authority.

lives, she haven't been the superintendent of insurance and a main edit officer -- in maine. theave asked her to discuss marketplace which is one of the handful being fully run by local jurisdiction. thank you very much for coming on over. >> thank you very much. you had me there. i thought you would say we had a short amount of time. thecity did not sign contract with the system integrator on till january of this year. days were thetwo last to the picnic and out of the gate i am proud to say. were the last to the pavement get out of the gate i am proud to say. how important this session is and how critical the research that dr. collins has done on the

first eight weeks experience and certainly it is informative for everyone and especially those on the ground who could take the research and utilize it to be more strategic on our own outreach. thank you very much for your commitment to helping not only policymakers but folks on the ground implementing the reforms. thank you. in in the district, it it did take a village. i want to a knowledge some of my staff members. when i came on board in january after the executive director of adc -- d.c., i was the first employee and i stole -- the bestloyees employees i could from everywhere. i was very fortunate to have a great team to help us get to the

finish line. and i a great consultants see some of them here like david holmes and shelley who are all with us helping us succeed. one of the things that we did just like you heard from dan, we realize we cannot do everything. we prioritized and functionality. theook many things and all bells and whistles off of the table. we focus on the core functionality. we wanted to make sure we were open for business. and we were. he wanted to make sure that everyone am a all consumers and small businesses could come to us and do everything from start to finish. a were able to do that on october 1. onthey were able to do that october first. they were able to open accounts andshop and select the plan

say, hey, pushed the button. employers could set up accounts as well. this is our landing page. i wanted to make sure you were aware. site. not the federal we are a local site and we are fully functional. byhad great participation the insurance industry from the start. in fact, we have the major insurers offering coverage to individuals and small businesses of the individual side, we have aetna and blue cross blue shield. we have those and united health care. the fact that all of the carriers are participating through d.c. health link. there are significant choices available to consumers both individual and small-business consumers at all levels of

coverage from a bronze to platinum. employer and full employee choice in our shop. that means when a small business comes to us, they can choose to all of theorkers insurance products that are available in a particular level. if a small business offers a gold coverage, that means the workers can choose a different plan. level andn the gold there are 112 different products. they could choose from post to your the hmos and ppos and point of service. plansn get no deductible or a high deductible plan. full employer choice. if they want to offer different levels of coverage, that

employer can choose that as well. full choice. i wanted to include a slide on prices for the that has been in the news quite a lot. our premiums are very good and competitive. slide.you cannot see the hopefully, the one in your packet you can see. if you are 27 year old in the district of the individual side, you get a bronze level policy for a $124 a month. you can get a aonze a level policy for $295 month. very competitive. the same is true on the small group side. -- when we posted a doctors and legislation that required full transparency and pricing, we saw a real price competition.

we made the rates public. what insurance company came to the lowered their rate twice. one company came back lowered their rate wants. andird insurer came back added additional products. we in the district saw real price competition work through price transparency. competition greatly benefits individual consumers as well as small-business consumers. we have had a lot of activity in the district. lots of shopping at nvidia council being opened up. of shopping and accounts being opened up. requesting the invoice to pay. i am not encouraging anybody to pay early because they have until december 15 to pay. i want to make sure that anybody lives in the district watching

knows and they have until december 15 to pay. not at the last, some have paid -- and nine at the last, some have paid. eless, some have paid. i looked at the people who fully enrolled themselves and paid. selected the plan and paid. the largest category of enrollments in the first 120 we 31-40. age the second is 20-30. 51-60.rd category is making news here for you today. the other interesting observation is that most of those folks who already paid selected platinum level coverage. it actually surprised me.

i thought it would be more evenly split. the early birds have selected platinum level. the other interesting fact i would like to share with you is we have several enrollments eight 65 and over. -- aged 65 and over. i am not sure. i'm not sure if their drop and medicaid or if they are not eligible. that is something to pay attention to as well in terms of who pays -- and roles. -- enrolls. that is context information. moreu are looking at them at the marketplace, you can go to dchealthlink.com. i want to note in terms of and i will make a quick comment about hhs and federal implementation.

i was in state government when the legislation come on the affordable care act was being debated. they had a clear choice. there was a house version that had won a nationwide exchange and there was a senate version which had each state setting up their own. everyone of us, me included in state government, lobbied heavily for state based opportunities. we argued states can do it better. and we have done it better and we should do it. part of the issue has been that so many states who lobbied tovily to have opportunity set their own exchanges decided not to do that. to keep that in mind when we set expectations opportunityement

for success when you have the federal government having to set up a marketplace, a very complicated online >> all right, thank you very much. thatlast slide reminded me if you are tweeting about this topic in this event, there is a hashtag. @acamarketplace did i do that all right? >> you sound very twitter-savvy. is theal speaker executive director of legacy community health services. they are a federally qualified health center in houston. they have worked very actively

with both the aca and medicaid enrollment. she is here to share some of their experiences with both their patience and legacy itself. we are very happy to have that happen. katie? >> thank you ed and sarah. i will start with a brief andoduction of legacy is how our patients are navigating the system. ,he interest level we have seen some of our successes and opportunities, and our next that's. -- steps. texas, insoutheast paris county and jefferson county. we have 11 clinics. we have clinic locations and seven school locations. are located in historically gay neighborhoods, hispanic neighborhoods, and african-american neighborhoods.

we are a certified counseling organization. we have 20 certified application counselors. we will have approximately 60,000 individual patients. also, i would be remiss if i did not say that texas, adventure everyone in this room knows, is not a medicaid expansion state. therefore, only children, the elderly, and the disabled are eligible for medicaid. did not opt to do a savings exchange. we have one of the highest uninsured rates. our marketplace, and people have this, they walked in --

this, they walked in -- we have offered it to some people. they've heard about identity theft. there's been several groups in houston that have been out collecting information. they've been stealing people's identities. we have to get out -- we have to get over some of that anxiety. then we determine the client's knowledge. this has been interesting. we knew people did not understand insurance, but we had to do a lot of education, just about the terminology of insurance. people were coming in with low literacy to begin with. especially is made up of people who are uneducated on insurance. they are getting information overload at this point. they take information and make another appointment to come

back. or they continue on, and if they have all their information with them, their household information, what subsidies they may be eligible for, the different ways you can apply, we confirm the documentation and decide on a plan that is best for them. in the online application or in the paper application. one thing that has surprised all ofus has been also that 1/3 the people who come and have never used a computer. have a computer, but have no internet access. the remaining amount of people have a computer and internet access. we help people set up e-mail addresses and connect them with the resources that our community has. we wanted to be able to get low- cost computers. them in getting on and getting an application in

the marketplace. we work with them to determine what is the best plan for them. the other part is, about half now we are doing in paper applications. this is largely because of language issues. diverse community and online is only available in two languages. we tried to do all of this work in the language of origin of our clients. they understand it better. there are 11 linkages on paper and only 2 online. there's a certainly a time for submission. the next part is that if they have any information overload, we make sure that if they submit a paper, they will come back with their eligibility. that it is determining which plan is the best and making the application. it becomes very complicated, especially for our clients love chronic illnesses such as hiv, diabetes, congestive heart

failure. they have to look at the lowest cost plan on premiums, but it is not the best plan for them. it is not easy on the federal exchange to go through medication formulas and compare doctors and hospitals on different plants. you have to take all of those things into account. you have to explain what all of those things mean to people. eventually they get through the application process and choose a plan. who are we seeing? who's asking? inquiries since november 1. we have seen 1300 individual people. the average number of visits -- we completed 89 applications. we had 18 people go all the way through to enrollment. people coming in our existing patients.

we have a high level of trust with them. they are the ones who are getting through the process more quicker than those who are coming to us through various outreach groups or finding us on the internet. we are also finding differences in age and race across every difference of age we have seen. we have had quite a lot of people coming and over. we have also been helping them choose the appropriate medicare part d plan. we are helping on that side also. we are also helping young families who come in. we are pleased to see that. the children authority on medicaid. we are providing care to other family members. our successes and challenges. what is working? the system is improving. the awareness level is increasing. it has made people aware of what

is out there. it has brought more people in. surprised when they come in and how it is working. there is a preconceived notion, especially by people who are high risk or have chronic illnesses, that they have been unable to be supported. the pricesxchange, are affordable and people are surprised. we are doing a lot of referrals for tax advice in our community. we have a couple of organizations that do free and low-cost tax services, filing services for people of low income. we are doing a lot of that. we are collaborating a lot with other enrollment groups. and we are collaborating with other nonprofit organizations. what are the barriers to opportunities?

trust is a huge issue. the majority of people who commit do have a lot of interaction with the system. there is publicity that has been an issue, as well as online access and literacy. is,rstanding what a co-pay what coinsurance is, i just way premium is. security, itland is very large in our community. lots of people are fearful that while they may be citizens and eligible, their people and their household or families who are not citizens. they fear ins. they are also concerned that law enforcement make have this information available to them. mail accounts, a lot of people do not have e-mail accounts. issue is an inability

to compare easily the different plans on healthcare.gov. doing a steps, we are series of town hall meetings to encourage our patients and people in our neighborhoods to get educated in large education sessions. we are setting up in our lobbies, computers with online access for patients so they can come in and do some exploration on their own or get comfortable with the year. we are doing some computer literacy classes. we are doing assistance with that. we are continuing to do outreach and engage attentional. potential. in january, we will do health literacy for our patients. just because you have insurance, it does not mean you know how to use it. our goal is to make sure that we notinsurance, and it is

just for when you go to the emergency room. we wanted to be in the habit of visiting. that you have a health care home. >> thank you. >> thank you. right, we are into the part of the program where we give you a chance to check out questions that have been raised. that ifalso encourage you've heard something that you disagree with or you need clarification on, you should speak up at any point you would like to. and of course, sarah is in a position to ask questions. if you do go to the microphone, after you identify yourself and try to keep your question as brief as you can so that we can

get to as many questions as we can. you have the honor of the first question. >> bernadette hernandez, congressional research group. your initial enrollment data about people gravitating toward the platinum plan, there is a question about what you attribute that to? uninsured, ors are they over 65? are they looking for more generous coverage? beyond broadrd, any and premiums, is there plan to put additional information out there such as enrollment by demographic category, as well as traditional lan features such as cost- sharing?

>> i wish i knew is the short answer. should caveat all of the initial numbers begin by saying, i do not think it is a prediction of anything. it is just looking at the first periodsrds -- first 120 . the younger population is represented. in enrollment, you want to make sure that you are targeting everything. you need a healthy mix of people. i do not know anything about the insurance status. unfortunately, we did not build that data element into our application. we are not collecting it. we're planning to do a survey in 2014 of all the enrollees to ask them whether they were previously insured and will kind

of coverage they had. we do have plans to closely examine our data. probably early to mid-next year. when the dust settles. we have good data to look at. we will be making all of our information, demographics and enrollment statistics, available once we have the data to share. >> have others on the panel seemed the same kind of platinum enrollment phenomenon that she is describing? >> many of our soup and silver. that is what we are seeing. but we only have 18 so far. it is not a sample by any means. >> that is an excellent question.

everyone is looking at this carefully and wants to know who is enrolling. we will redo our survey that we -- knocked over in december that we did it knocked over in december to get a better idea in a broadway of who's coming in. and we will go in at the end of the open enrollment. -- we will go in at the end of the open enrollment period. we will take the first national look on a broad market level starting in september. we will know what the first quarter coverage looked like this year. report's and the report just now -- and other states are reporting

demographics, it will be very important to understanding what is happening. >> all right. i am a legal intern. i have a question that is mostly caldwell.t katy >> can you get closer to the microphone? >> my question is directed to katy caldwell. how is your health center responding when you encounter who are below 133% of the poverty level? people realize if they are eligible for subsidies? yes, we do help people determine what their subsidies are. that is the easy one. the hard-won is telling people

that they are too poor to get a subsidy. it is difficult. whoave had people coming in falls in that category. if we had expanded medicaid, they would be eligible. we are talking to them about what you normally do. here are your options, and if you come here for care, we will help you in any way that we can. funds and using grant other funding that we have to help them. them withs to educate all of our patients and keep people out of the emergency room and into urging care. care.ent ask to put a data point on it, the size of that population is about one million people in texas. that is a huge number of people.

>> go ahead. question is are you concerned that with over 100 plans to choose from, people will be overwhelmed by the choices? it was a problem for medicare part d and it is still a problem for part d. people are reluctant to go back in. that they doown not make the best choices for them. >> thank you for the opportunity to clarify. have 34 products, and 31 -- three are catastrophic. on the individual side, there are fewer choices. side, 257 different products.

we know from experience that small businesses them selves like choices. if a $15 co-pay is right for one small business and another small business wants a $20 co-pay, we know that from the massachusetts connector periods -- from the massachusetts connector experience we know that. we have a lot of input from policy workgroups. we decided early on that we did not want to limit product. we wanted carriers to be as innovative as they wanted to be. the one early decision that we made which was unanimously recommended by a variety of groups and carriers, it was that benefit not allow

substitutions to the benefit packages. benefits likeonal acupuncture, as an example, but it is not a core benefit. in productsn includes additional benefits on top of the essential benefit. the variation in your out up rocket -- out-of-pocket life. >> thank you. you.ank i am with voice of vietnamese americans. with theon has to do language barrier. have you seen problems? you have 11 languages on paper, and only 2 lane which is online for the application. we have a high percentage of asian americans and the number is rising.

i don't know if you have numbers from healthcare.gov. how many asian-americans are coming in and having problems of that? do you think the community should step up and work with you? we have groups in virginia and we have a terminus amount of asian-americans. many of us are not happen at having insurance. of having insurance. >> we know it is a problem. we have a large vietnamese community in texas. get the third to language become vietnamese frosts. -- for us. it is a problem.

we are glad that there are at least 11 languages. we have run across people where we do not have the appropriate language. it is an issue. for people toier understand in their only which of origin. everyone tong with try to get better access. the answer is yes, it is a big barrier. district, our biggest immigrant population is spanish- speaking. the next largest is the ethiopian community. we also have an asian population. for asian and pacific islanders, we partnered with the mayor's office. they are doing on the ground work. withund that working culturally different groups,

having a working online portal is not relevant. many people in the immigrant community, small business owners and individuals, they like the one-on-one on one interaction with a trusted voice. we actually have focused a lot of resources into the on the grounds aspect. people in the community who can work one-on-one with the small business or the individual. they can work of our diverse populations. >> will kind of relationship do you have with the insurance brokers industry? >> from my perspective, excellent. we actually have the brokers involved very early and we developed a broker reporter --

broker portal. there is a separate broker portal that is designed to make it easier for brokers to shop. enhancementssome to our portal based on feedback from not only consumers, but also brokers using the portal. we also partnered in a formal way with the national association of underwriters. they did all of our broker training. that helped a lot. we also partnered with business associations like the d.c. chamber of commerce the restaurant association. that is held a lot in terms of not only educating people about the affordable care act, but also being trusted messengers. those business partnerships are

helping us in the moment as well. >> thank you. lmi, more toms, this discussion, i laid a let a foundation program where we tested voluntary subsidies for the working uninsured. interested, mila and those of you have had a chance to look at these plans, some of them will have to have narrow were networks. i would report that there are no easy ways to make health insurance affordable. these from lot of purchasing cooperatives to subsidies to narrow were -- narrower networks. those early projects help to mend the laws in smaller markets.

uninsured were not unwilling to use their own networks. they wanted a range of care from hospitals to ambulances and so forth. i'm wondering if you are hearing any or seeing any evidence that looks like this will be the next issue that people want to draw out here. not everybody is going to get the same choice of health providers that maybe they had before. >> i can tell you that in the district, the products that are inng offered are very much, terms of the provider network, they are the same as commercial insurance. about half of the products offer , and the other half are robust and local regional provider networks. productnot a single that was filed through the d.c. health link that had what we

would consider a narrow network. >> i might add that i would say that from my perspective, narrow networks, it connotes different things. it does not necessarily mean add quality. her a lot of providers out there that we want to be connecting with. it is an indexer will move in the insurance industry in this country toward narrower networks. selective contracting. you will have high-quality and low-cost providers. present --ry to pretend like that is not stereotyping. pricing for a number of private- sector entities were moving in that direction. >> i believe you were next.

>> hello. i am from the office of general counsel. i had a question for dan and mila about the bells and whistles that you are referring to. both of you referred to bells and whistles in the system and you pointed out that one of the that led to the implementation by d.c. and other states was that you cut out the bells and whistles. comparing that to the federal system, it has to interact with the hub and the carriers and make the decision for the applicant. what are some of the things you can scope out? what are the bells and whistles? record, i did not say that we scooped out anything. we intend to do everything that we had planned.

we just could not do it for october 1. our emphasis shifted into 2014 and future years. the provider network has been great. ideally we would have a button that a consumer could click on and have access to the carrier'' networks right there. we could not build a feature into the portal. what happens now is that a consumer has to click several times. they have to click onto the carrier site. then they go to the provider networks that the carrier has on their website. example of something we could not do. not for the october 1 launch. we plan to do it, but it will be 2014. >> go ahead.

i am name is dan brown and part of the american occupational therapy association. the lowest cost option is not always the best option for consumers. ty also mentioned that it is difficult to access information about provider networks. we have found that it is difficult to access information about covered services. substitution of benefits is usually allowed, even if the consumer is aware. there could be variation in the marketplace. of thendering with all i.t. problems and enrollment challenges, if d.c. or other state-run exchanges are actually looking at the consumer experience and making sure that all the information that ideally would be available for consumers to make informed choices, is available.

a related issue, that the data is accurate. we found some information that is available on the marketplace as thece is not the same summary of benefits and coverage for the plan. i am wondering if any state-run marketplaces are looking at the availability of that information and the accuracy of that information for top -- of that information. >> yes, and yes again. we found early on in it was very difficult to find some formula. we work it carriers to make that more prominent and easier to find. but again, that formula is not going to be in our portal until next year. consumers. faq a few clicks to get to the formula. the consumer experience -- let me just say, the most export --

the most important part of all of this is the consumer experience. if the consumer has a bad experience, it is harder for the consumer to sign up and get coverage. interested in that. is constructively phrased or not, we take the aryans seriously. experiencethe seriously. changes tomake improve the consumer experience. you do updates to our system on a together basis to add in enhanced features to help with the consumer experience. in terms of the contradictions in information with the summary of benefits and coverage and what the plans actually cover, just like we build the portal for brokers, early on we built a

portal for carriers. tos summer, carriers had upload the rates of the plans and we had significant back and forth testing with the carriers. they would come in to the portal and check everything out and make sure the summary of benefits and coverage actually matches the plan that was approved for sale. they had to make sure there were no discrepancies. that is how we were able to address some of the discrepancies in the plans that were not identified early on. hopefully consumer shopping and d.c. and finding a discrepancy, if they do -- i wanted to tell us. we will address it. andconsumer experience improving the user experience, it is critical to me. >> the federal health benefits program, i have a few questions.

with the medicare expansion, and soldiers coming home, how are we going to help that large population transition, even if their state may or may not be offering it? the jobs may or may not be there. income is lowered. question, is for the state. we have access to health care, now what is the state proposing to build up the clinical providers side so we can provide ?eople with health care that has been added to the mix now. >> that is a great question on returning soldiers and veterans. i can say, i am not sure. this is not traditionally a job that medicaid takes on.

the core issue that you're getting at is employment opportunities for veterans. it isn't important issue. a lot of people -- it is an important issue. a lot of people are focused on it. we can't really address that. to the extent that there are issues there, we will take a look and get back to you. aspect ine one other the second question about the inadequacies of the provider networks. whetherwas wondering there is any state that has decided to hang onto the primary care increment and medicaid that was included for a time at federal expense in the aca. questionnaire -- one of

the things the aca did is that increased medicaid payment rates to primary care doctors to the medicare level. that was great. years, in fact, it was intended to improve access. one of the first years that it went into effect was 2013 when this expansion started. it ended the year 2014. i think that is a terribly cynical policy. assumed as of the law future congress would come in and extended. and we would have a medicaid fix just like we had so much success with medicare. premature is way too to say what we are going to do. it is very much in congress cost court.- congress'

that is a question for congress to not cross. we will not try to answer that this point. >> rebecca adams. mila. a question for first i want to ask matt, he said that medicaid is changing. are you seeing different people enroll? data that the enrollment has been delayed because of software problems, are you concerned about how solid the data will be? you have expressed some concerns that people who enrolled in applied rorty enrolled in medicaid. howl will that data be? do you envision any way at all for people who

been assigned to go to health link to be able to go back to their previous coverage? >> the first question, in terms of the data, you are right. it is fully functional. it will come. i don't know that it is a catastrophe. the issues you are getting at around some of the data, factual errors that may be coming -- here is who we think will be coming to you. here is some information about them. so states can better prepare some of their workflows and call centers. we have seen some challenges there. there are a lot of challenges with heavy data at the onset.

i am not terribly concerned about any of that. this is not going to be a huge problem i don't think. to theuld refer you affordable care act's provision that says that it may designate certain staff members who have to get their coverage through exchanges. the final rule showed as the source for qualified coverage for aney are eligible employee contribution. i welcome all congressional staff and members and look forward to serving each and every one of you. >> go ahead.

>> stacy collins, with the national association of social workers. are either of you, at the agency level, collecting any data about the turn away rate in the expansion? you mention there were 3000 inquiries. if there's any data on how many people were below the poverty line and could not get coverage because you are in an economics expansion state. as i do not know the number off the top of my head, but we are collecting that. we are going to be seeing a lot more. we are a historic hiv provider. we have thousands of hiv patients. that aboutour data 1500 of those patients will not qualify. they would qualify for medicaid expansion, but not the other.

we are tracking it. the short answer is yes. >> the short answer is no. we are not tracking it. have 1/3 of our staff here today. we are trying to prioritize with providing correct information to members that we can implement. the snapshot we have been doing are to help states figure out, are you struggling with this issue or that issue? we want to know if everyone is struggling with it. todo not have the capacity really be aware -- a warehouse for everything like that. >> someone else had a question related to that. they wanted to know if states that were using alternatives to traditional medicaid expansion statesaw, whether those see differences in enrollment?

know that we would see much in terms of differences in enrollment. at this point, we are only really talking about the exchanges. expansions a medicaid and then the supreme court declared it unconstitutional. it turned the medicaid expansion into a state option. about half the states has said yes and the other half of said no. the only choice they have had. yes or no. we have had an interesting scenario where a democratic governor in a conservative legislature went to secretary sebelius and said, i need to do the expansion. i cannot get it through. let's figure out a third way. planher they worked out a to essentially expand medicaid, but did take the vast majority

of those individuals and enroll them via the exchanges. by the marketplace. -- a thingmiums called premium support. arkansas has been the only state to do that. --t we are going to see is you are going to see the figure, the frail or individuals will be in medicaid. pool wentr, healthier up in the exchange. intention, according to their calculations in the proposal, that is going to sustain and save the exchange market. by having that influx of younger, healthier lives. you will see a lot of focus on that. i guess this is part of the

same question. i want to address it to you. know, if more states have opted out of the medicaid expansion who will be using that to un-hat they are using enroll people from medicare and put them on the exchanges -- i want to hear whether or not there is a downside or upside to using that kind of model? will other states do the same? i thinkrms of medicaid, the wisconsin issue is different. folks say why do they keep getting labeled as a non-expansion state. they have expanded. they cover all of these people.

i think the wisconsin situation is very different. it is a very salient question that we talked about. what does arkansas mean for the other 24, 23 state that are currently leaning no question mark -- leaning no? states thatority of fit into that category are, i ," butcall them in the "no looking for a way to get to yes. the options that they have our expand the program as is or nothing. they think there has to be something more on the menu. there has to be another option. is there another option for us? at the end of the day, it is all about whether those individual states, and they all want

different things, pennsylvania, michigan, iowa -- they are all asking for slightly different things. is the administration going to be willing to work with them to come up with a fourth option? if this option? it way to get to yes. with thesas model conservative flavor of the private sector and a way of exchanging -- strengthening the exchange market, could be a way for everyone. raises a question that dan brought up earlier. management inplan 14 states. we are doing more and some of the other states. that responsibility to, taking

on more marketplace operations. is allowing states to transition from a partnership to a federally-facilitated marketplace. states that we are anticipating filing a blueprint soon. states that are interested not transition will have to file a transition blueprint. they have until the end of 2014 to make that decision. we think there's a lot of impetus for the partnership states to transition over the next few years. we will have to keep an eye on those states and see which ones do. as we get into our last 10 minutes or so, i would like to ask you to pull out the blue evaluation forms and will them out.

i would like to ask you to ask questions. >> i have natalie. i have two questions. the first one is about the enrollment data that has been released about young people. target? -- ifn that data on target? does it represent a a lot of work that needs to be done? how does that data in form your strategies for reaching out to that group? about how datag is helpful to adjust outreach strategies. what is the data telling you about what is working or what needs to be done? are there things being done to laurent those for crafted lure in-- being done to those procrastinators? week in states

and places that were reporting significant shares of young adults, 20% of those who enrolled were in that 19-35 demographic. in terms of what you were suggesting, we expect 70 million people to come to the exchanges next year and 2.5 million will be people between the ages of 19-35. about 38% of that total. october,y data in people who visited the marketplace that the people who were uninsured eligible to come olds.re 19-29-year- olds.ere 19-34-year- a high percentage of young adults, and they are no different across age groups in terms of people who said they would go back to the marketplace by the end of open enrollment

young adults may have waited longer, but the uninsured rates among young adults, 21% in the year prior to that. to 8.0%. may drop it points to the surveys and the research that we have done. these numbers might help do what we need them to do. it may stabilize the market and the premiums over time. >> we use all sorts of information sources on a weekly basis. i have a meeting with my senior folks every week looking back at what we know about enrollment and those were on the grounds.

eveningan event in the result in five people showing up. at lunch, you get 50 people to show up. we look at everything that has happened, including what we are hearing from rdc help groups. -- ec health groups. we are shifting our strategy. i can tell you that a weak one we had a lot of events land. there's a term for it. we have a range of prices and products. we found that consumers were coming and ready to enroll. we were making sure that we have brokers and assistants at those events to help people actually enroll. we know a lot about the needs and demands. we are making sure that we are right there to help people

wherever they are in their decision-making process. are there any specific strategies to reach out to young people? specific outreach programs? rdc health assistance includes young invincible's and other groups that have worked with university populations. they are doing very creative things. bars top is going to provide information. they are very creative. the one thing that we are not doing is door-to-door. going into people's homes. we have essentially said for a number of reasons we will not allow that activity. but they can be as creative as possible.

we ask for daily and weekly updates and we share them with the group. >> can i ask one last thing? learnednutes ago we that he sign up for coverage for you have until december 23. have any of you guys decided on what you are doing? >> we are pushing for december 15 two enroll and fully pay for coverage to be effective january 1. >> we have time for just a couple more questions. one is directed specifically to you. your mention of the direct -- theent option

questioner wonders whether that raises technology issues. what potential will is option have for increasing enrollment? >> that is a great question. we do not intend for healthcare.gov to be the only channel for enrollment. they did not anticipate that they would be the single channel for a moment in every state. there is a provision in the law that allows carriers and other websites to directly enroll consumers directly from their platform into the exchange. enroll, i meanct enroll in a plan that the carriers are offering. or that the brokers are offering. there has been a lot of confusion in the media about this. the president announced direct enrollment and there is not been

a lot of information about it. how works is we are providing facilitate the marketplace space. these technologies are called apis. they allow brokers to plug into the ffm. there has been some confusion and misrepresentation in the media, saying you cannot do that. you only get a premium priced roughly through healthcare.gov. what you can get a premium subsidy through direct enrollment. technology allows that. you can go to a brokers website, pick a plan, and you are securely transferred to the federally-facilitated marketplace. and youo the exchange calculate your premium subsidy. then you go back to the carrier 's website or the broker's website and you complete your

plan is chosen. as of today, only carriers that theworking directly with federally-facilitated marketplace healthcare.gov can use direct enrollment. while the technologies have finally been completed, they were supposed to go online october 1. there were a lot of issues. on october 1, a lot of the carriers and web brokers were still trying to complete. correct me if i'm wrong, but i am not aware of any changes that are facilitating direct enrollment this year. but there are some that are planning to facilitated next year. it was the intention to provide multiple channels for consumers to enroll. the exchanges, healthcare.gov, direct enrollment. it is late in the game to speculate on how well direct enrollment will work. technology was not completed

until just a couple days ago. for many, the direct enrollees are still working on integration issues. >> any final observations by any of our panelists? >> i just want to add one more thing. for people moving talking about consumers and this process of direct enrollment. health plans actually have to let people know that they are available, and that there are other options available to them on the marketplace. thatly it is a way enrollment might increase. we want to get to that the summer 23rd day. date.ember 23 consumers can opt out of direct enrollment anytime they want and go to these eight

exchange. state exchange. >> i want to make a plug for tomorrow. we have enrollment event. we will have health screenings and bring your whole family. i encourage all of you to come out. >> ok. to comeappropriate way to a conclusion of this discussion. come back to this topic sometime in the near future. there may be a few remaining issues. we will need to tie them up in a neat bundle here. we have learned an awful lot, or at least i have. ,eminding you as we finish up to hand in those blue evaluation forms. i want to thank our colleagues for their help in planning and obviously making a big

contribution to the success of this briefing. thank you for some of the best card and microphone questions that we have had in a long time. i will ask you to join me in thanking the panel. [applause] happy thanksgiving. [captioning performed by national captioning institute]

span, some live- tv coverage from the day of john of case assassination in 1963. and then two ceremonies honoring the president of the united states. today marks the 50th anniversary of the assassination of john f. kennedy. next is some of the nbc live news broadcast. it began with anchors receiving